prestige residencies

This is a topic that gets brought up every 6 months or so and there are previous posts about this. You'll also get differing opinions about this.

IMO, the short answer is that the "name" places are not really important unless you plan on an academic career AND have your heart set on one of the Ivy league centers. Some of those places can be a bit inbred and it could be more challenging to break in. But essentially, if you want to go out and work in the community then it makes no difference where you trained. It also makes little difference to stay in academics other then some of those Ivy league centers.

Chimed said:

This is a topic that gets brought up every 6 months or so and there are previous posts about this. You'll also get differing opinions about this.

IMO, the short answer is that the "name" places are not really important unless you plan on an academic career AND have your heart set on one of the Ivy league centers. Some of those places can be a bit inbred and it could be more challenging to break in. But essentially, if you want to go out and work in the community then it makes no difference where you trained. It also makes little difference to stay in academics other then some of those Ivy league centers.

Click to expand...

You have learned well, my young Padawan...

I think a lot of medstudents see this as applying to college or medical school because that was the last and most similar experience.

The Ivys and other name-worthy institutions, all things being equal, are likely to give a great education. Unlike college, IMHO, applying to a residency is more like applying for a job-in-training than applying to college. Other factors needs to be put into play such as where do you want your career to go, where you want to be, where you are in your life, etc.

I'd certainly recommend the most prestigious residencies for someone who wants to do research and work in academia, but that is still a simplistic way of looking at it.

E.g. Some of the best researchers in a specific field aren't in programs that most consider prestigious. If you are interested for example in DBT training, you might want to consider University of Washington. What? Not Columbia or Harvard? Linehan is the founder of DBT and an avid and passionate teacher and is a professor there. If you want to go into forensic psychiatry-Case Western or any of the Ohio programs, U. Mass, U.C. San Diego could be considered. All of those areas are attached or very close to outstanding forensics programs that are not part of the name-brand club of learning institutions.

A similarity to applying to college is simply going to a college based on a name does have benefits, but you'd reap more rewards by looking more deeply than the name. The Pasadena School of Design (PSD) is likely going to be a better school for an artist wanting to work in video games than Cornell Art School, but Cornell is part of a name-brand. No one's heard of PSD outside of those close to it or those working in the art field.

That is not to underplay that several of the name-brand institutions are good if not spectacular. Just don't let that be an end unto itself. I know a few forensic fellowships at name-brand places where the fellowship doesn't live up to the name.

Other considerations to think about:
-Sometimes it is nice to be a big fish in a small pond rather than a little fish in a big pond.

-Sometimes (not always, but sometimes) "prestigious" places breed a malignant atmosphere. Sometimes faculty members have a high opinion of themselves because they are at a prestigious institution. Additionally, some residents will put up with any amount of abuse to have a certain "prestigious" name on their CV, so the prestigious places know they can find a number of other strong candidates to replace you if you aren't happy. That sometimes means they kind of take residents for granted.

-If you are looking at a program because some famous psychiatrist is affiliated with the program, try to investigate how that actually translates into opportunities for the general psych residents to work with that psychiatrist.
I interviewed at one place where the residents admitted that the famous psychiatrist on faculty there really wasn't very approachable or accessible to the general psych residents. I respect this psychiatrist's work a great deal, but it doesn't help me to happen to be at his program if he only really wants to deal with the fellows!

-Since available mental health services and state laws about involuntary commitment can vary somewhat from one place to another, it is probably a lot easier and more convenient to train in the area that you want to end up living in rather than moving across the country after residency. You'll also then have a chance to develop a reputation and local connections throughout residency.

As whopper noted, the famous medical centers don't necessarily have the best psychiatry training. A lot of times these famous medical centers are famous because of their internal medicine departments (usually; sometimes places famous for great patient care aren't necessarily great educational experiences even for IM residents). Well, IM is only four months of your training (if that). That doesn't tell you much about how the people who run the psych department are. It is sometimes better to go to a program where psych is the strongest department and very well-respected within the medical center even if that doesn't translate to going to the most famous place.

For these reasons, I definitely think it is important to try to be honest with yourself about where you will be happy. Sometimes I think psych residents worry about prestige because we feel like we have something to prove (namely that psychiatrists are "real doctors"). I say go ahead and see if you like the prestigious places, but don't feel obligated to rank them high just because everyone will be impressed by the name.

I interviewed at one place where the residents admitted that the famous psychiatrist on faculty there really wasn't very approachable or accessible to the general psych residents. I respect this psychiatrist's work a great deal, but it doesn't help me to happen to be at his program if he only really wants to deal with the fellows!

Click to expand...

A very specific person comes to mind when you bring up this post but I'm sure your person isn't my person.

Simply because someone is a famous psychiatrist and at a name brand institution does not mean they are a good teacher. Some noteworthy people in the field don't like to teach but are great in other areas such as research. I am thinking of one particular psychiatrist that several people dread dealing with but he's highly respected in the field.

Now if you happened to find a psychiatrist who was highly respected, is a good teacher, and taught something you were passionate to learn that's different. While the name-brands do have plenty that fit that description, so do plenty of other places.

Hear, hear!

But let's suppose someone is single and content to move anywhere (has done the small town thing, didn't mind it at all), and is looking for...
- program with very intelligent, motivated, yet normal and laid back residents that values hard work
- confident faculty without suffocating arrogance (wants to work hard but does NOT want to feel like cheap slave labor)
- program that will open many doors (academic, specialized, administrative, research...) for the applicant that doesn't want to do community psych
- heavy on biological psychiatry
- great CLINICAL training (since in the end, this is really what will matter the most for future patients)

Where should they be looking?

(I've read a ton of threads, but there seem to be SO many quality programs out there, having a hard time narrowing it down...). Any feedback would be greatly appreciated!!

I understand what you mean. Wouldn't it be great if there were a program that filtered through everything you wanted?

To make things simple, I'd focus first on geographical area and what you want to do in the field.

Consider where you'd like to live at least for the next 4 years if not the rest of your life. Several doctors end up practicing where they did residency, even if they did not intend to do so in the first place. When you've been in a place for 4 years, built connections, and know the area, sometimes life just takes over.

In that area, get a list of all the programs, and start there. This will greatly narrow down the list. Ask about those programs from any source you can get.

Also factor in what you want to do with your training. As I wrote above, if you are very dedicated to research or academia, that may be more important to you then what goes on with your other factors in life. It may be that you will not mind where you are so long as you are in a program where your professional desires are satisfied. This is a personal decision.

getsmart,

i feel your pain, i'm in the same boat. no ties, want a big move so no specific region, and am still unsure of where i want my career to take me... like you, i really have found no list of the "best" programs, and am FINALLY (after much research) beginning to agree with everyone who keeps repeating, "there are no 'perfect' programs, just the best program for you." i think we are blessed with a field that gives us many opportunities for excellent training because it's just not as competitive as say plastics or derm. in the end, i applied broadly (a bit overboard to be honest), and am now sorting through programs as interviews come in.

however, keeping true to this thread, i would also like to know which programs are the most respected within psychiatry, and. like getsmart, which of those have bearable egos.

np

I think a very strong academic education is useful regardless whether or not you enter academics. Not only will you be a better doctor but (seems to me) you'll be less likely to get sloppy and burnt out later in your career.

It's also clear that plenty of top-rung academics did not train at top-rung institutions.

Having said that, these are some of the places that previous posters have listed as tops:

1. "Barclay" and "Doctor and Geek" researched which places had the most MD/PhD residents, which was considered by some a marker for an ability to attract and recruit researchers. This list is from 2009.


MGH (10)

Cornell and UCSF (9 each)

Columbia (7)

Yale (5)

UCLA (4)


2. Wellfleet said:
The most competitive programs are MGH/McLean, Columbia, Cornell, UCSF, and (maybe) UCLA.

NYU, Stanford, and Longwood are not that far behind. "Most competitive" doesn't mean "best", and I don't know if it's a good thing that all of your co-residents are AOA or MDPhDs from the ivy league

Also, the most competitive residency programs are not necessarily in the best psychiatry departments. Hopkins, UCSD, Penn, Wash U. and Pitt all have very strong departments, but admissions selectivity is not that
"competitive".

3. Aesop ranked them as follows:
1 or 2. MGH/McLean and Columbia
3 or 4. Cornell and UCLA
5. UCSF

4. Sneezing disagreed and made the reasonable point that there are lots of excellent places:

I intentially didn't apply to any of these programs talked about here. I couldn't imagine living in any of these places.

I also have a hard time agreeing that they are superior to other programs like Iowa, Wash U, Mayo, Cleveland Clinic, Case Western, Vanderbilt, U washington, U Cincinatti, and some of the programs in Texas or further in the SE that all have sizeable research programs.

Newpsych,

The most respected residency programs as it pertains to careers are the ones with the strongest departments of psychiatry.

I think there is some truth to the notion that some of the more liberal elite cities with large fee for service populations of patients (like NYC, Boston, San Fran, and LA) having a relative rate of increased competitiveness to get into.

However, in psychiatry, no boss cares how competitive your class was or where you classmates came from...all they look for is your level of competence and one way they do that is by looking at the department you trained in and what kind of exposure you had. Also, working with famous names or well regarded specialty programs can be impressive and put a feather in your cap...not to mention help if you need professional references.

Medical students seem to get caught up in playing the rankings game and get myopic about what matters. To be clear, the rankings game can matter, but no upper level administrator, dean, or physician looking to hire someone is going to care or even know the nuances of how hard it was to get into the residency program at Penn vs at UCSF for example. They just know that both are excellent departments with different strengths and the candidate from one or the other might fit the needs of what they are looking for better(and they might have a regional bias). The individual matters by far the most, as do professional references and specific experiences that might fit the job profile. Its just like any other job hunt after residency. The petty crap about getting into "the most competitive residency" is more about a person's self esteem (or lack thereof) than it is about strategically planning a career. Many thoughtful and smart medical students choose places that wouldn't be considered the most competitive, even though they would get in before others, because they have other specific priorities and make an informed choice about their future.

Just as a note.
CCF does not have a great program. I interviewed there because I thought they would have an amazing program. They most certainly do not for a place of that stature. Very few attendings (the ones they have are pretty good but not amazing) and not great overall exposure. If you are a top candidate and want to consider Ohio, I would stick with Case Medical Center (I hear UC and Ohio State are excellent as well) even though it is not 'ranked that high.' I have met a couple of their forensics people and they are excellent. I met an adult psychiatrist from there and also well trained with excellent psychotherapy skills.

I think program 'prestige' does matter. Especially regionally. I would much rather hire a regional candidate, then a state candidate vs someone from...lets just choose Ohio. National prestige also has some play, even in the community. In my region I am much more likely to choose UCSF, Stanford and UCDavis candidates although other excellent residencies are out there. This is both to hire and to choose as my physician. Its what I know and what I was comfortable with growing up.

If you are going to go work for Kaiser, it probably doesn't make any difference.

worriedwell - thank you for the advice. i completely agree. after reading through many, many threads, like cleareyedguy said, it seems to be clear which programs are the most competitive. but that was not really my question, which i guess i didn't make clear. i was inquiring more about which programs have the best training overall and will leave me with the opportunity to do whatever i choose after residency.

manicsleep - thanks for the post regarding CCF. that's the kind of stuff that's hard to find out before interviewing.

You want a program with a good combination of clinical exposure, research, quality teaching, lifestyle, and potential future opportunities.

Take for example just the following:
Clinical exposure: the different types of rotations available:

• Emergency psychiatry
• PACT/ACT teams
• Inpatient: Voluntary and/or involuntary
• forensic psychiatry
• child psychiatry
• eating disorders
• ECT
• psychotherapy
• long term inpatient psychiatric facilities
• consult liason psychiatry
  

Several programs I've seen do not offer all the above. Where I did residency residents were split between two locations. At one we had all of the above except for long term units and an eating disorder clinic. At the other, they didn't have PACT/ACT teams, involuntary inpatient or emergency psychiatry. Trust me, if you didn't do one, you will not be prepared for it by the time you graduate.

We had a 4th year resident come over to the other location as an elective who never did involuntary inpatient. She didn't know how to fill out involuntary commitment forms. She was like a first year resident all over again.

In addition to the above, the location the program covers could be important. If you're in an inner city residency, you'll see several drug dependent patients of a sort (poor, unemployed, cocaine dependent, 13 year girl who is prostituting herself to pay for her crack). In a program in the middle of the mid-west, the patient profiles will highly vary and you'll see drug dependent patients of a different sort (farmer who cooks amphetamines and is dependent on them).

For that reason, IMHO, it's better to be in a program with a wide diversity of patients. You'll want a program that covers a large geographic area or one of high population density for that reason. In a program that covers an entire county, you'll see a much wider population diversity than one that is only covering a few blocks of a city.

The only way to find out is to ask the programs. Ask during the interviews, ask what type of patients they get, and how far an area they cover. Also bear in mind that programs will often want to sell themselves to applicants. For example, if ask that you are interested in seeing a diversity of patients, the program may respond "well we have a a large immigrant population" when in reality-- over 90% of their patients are Russian immigrants because the specific neck of where their hospital is located is in the heart of little Russia in a big city (And yes, some programs are like that). I'd hardly call that diversity.

You'll want to know the quality of the teaching. Asking residents who are able to answer freely is key here. Several programs will have residents answer, but only in the presence of an attending which will likely reduce the odds of getting an honest answer.

What program will leave you with the most opportunities? Again, depends on what you want to do. Most programs, at least at this point, will open the road to several fellowships. It's highly possible for even a poor resident to get into a name-brand fellowship. I know because some of the worst residents I've seen got interviews at places like Columbia, Johns Hopkins, Harvard, etc. What's going on here, IMHO (and someone correct me if I'm wrong) is that the pool of available applicants going into fellowships is smaller than other fields--leading to this effect. I actually had a buddy of mine who was a terrible resident, and I talked him out of going into fellowship. I flat out told him "we both know you're lazy. You really want to go into fellowship? You're going to graduate from your program because they tolerate bad residents. You really think you're going to do well at Johns Hopkins?" One of the worst residents I've known got into one of the most competitive fellowships. (Now that's a story that'll make your eyes roll, but I won't mention it more here.)

Competitive programs will certainly open a wider door to academic and research positions. They also, more likely than not, will be great programs. Again as I wrote before, be mindful that the name will not always match the quality of the program, and if you really know what you want and it's a niche, some of the non-famous programs will have name-brand people who are great teachers such as Marsha Linehan at U. of Washington.

Whopper, your posts are phenomenal!

Clinical exposure: the different types of rotations available:

• Emergency psychiatry
• PACT/ACT teams
• Inpatient: Voluntary and/or involuntary
• forensic psychiatry
• child psychiatry
• eating disorders
• ECT
• psychotherapy
• long term inpatient psychiatric facilities
• consult liason psychiatry

Click to expand...

Some additional types of rotations/options available: Often these are available as rotations through other departments.

Geropsychiatry: Must have at a decent program
Addiction: Must have at a decent program
Sleep: Should at a decent program and must have at a good programs.
Community Psych: Should have at a decent, must have at a good program
Pain: Usually availble at university based programs.
Exposure to Veterans: I have little exposure these days but I found it invaluable.
A dual or triple board program (med psych, neuropsych, FP-psych, peds portal etc).

A lot of people think, well I am not interested in all that stuff. I just want to do x. The fact is you will see everything eventually and if you have trained in a place that has all that available, it makes you think with a much wider differential diagnosis.

You do have to balance that with the closeness and warmth of the smaller programs. The larger a place gets, the more isolated you will get. I think a top notch program with a smaller number of residents can't be beat. The rankings are relatively useless unless you wish to go into academics and even then they count for little in the long run.

To find a best fit for yourself, you really do need to know yourself.

If you have a very focused research interest, then it is often best to search out the handful of places that have an expert (preferably a cluster of experts) in your specific field. It won't do you much good, research-wise, to go to a place where you can't find a mentor.

If you have a strong and specific service interest, the situation is--I think--more complicated. For example, if you really want to focus on the underserved, public policy, forensics, or global health, I would argue that you should try to get the best possible overall training and then do a fellowship in those areas. In other words, if I wanted a forensics career, I wouldn't necessarily pick a residency that would give me a single month of forensics and then 47 months of mediocrity. On the other hand, if you're 70% sure you want to do something, it is VERY helpful to be exposed to faculty who have made that their career choice. Not only can they get you the fellowship, they can be role models and writing mentors.

Also, never underestimate the importance of peers. Who will you be training with, learning from, cross covering, dating, becoming life-long colleagues? What will they be doing when they graduate, when they're 40, when they're 60? To what extent will they be enriched by the field, or jaded? Will they be happily ensconced in a private practice? Unhappily stuck in a private practice? Will they be running academic departments or writing books or practicing psychoanalysis? Which of those things matter to you? It's a crapshoot in regards to your specific class, but history does tend to repeat itself. I have visited two residencies where everyone (including attendings) routinely clears out early, no one does any reading or writing, few people are especially interested in psychiatry, though some people do fellowships at least partly to transition to a fairly routine job. They did seem fairly happy, but I know that I would have become frustrated. I have also seen residencies where everyone routinely overworks, which would not fit the personalities of some applicants but is more comfortable for me.

I would also be suspicious when programs tell me they are just about to turn around or are closing the gap with better regarded programs. I have heard such comments from several programs that I know fairly well, and I've heard the lines from these same programs since the 1980's.

Strong chairs can be a mixed bag. I know some who are actively involved with any residents who show an interest, and others who don't know any residents' names. This latter issue can be a problem if s/he is the only big fish and/or you have gone to the residency assuming constant exposure to the big fish, but may not be a big deal at all if there is a strong group of big fish at that department.


I would also be skeptical of opinions that are
a) formed by someone else's interview day, since that person could have had an unusually good or bad experience for reasons that apply specifically to that applicant and/or reflect random events (eg, it should be obvious when someone says 'that program is terrible, they never even contacted me for an interview' or 'that program is great, the chair took me to lunch'), but there are lots of relatively subtle ways in which people's opinions are faulty.
b) formed decades ago by senior faculty at your medical school. Things can change significantly in 5 years, much less 20.
c) based on an overall medical center reputation.
d) unlikely (eg, so-and-so place is completely ... [fill in the blank, analytic, biological]). Any reasonably large department will inevitably have some variety even if there is an overall bias in a certain direction.

I would also be aware that much of your training is up to you. Are you prepared to read up on your own? Work hard to write good notes? Constantly be on the lookout for both paper topics and writing mentors? Be skeptical of your own preconceptions and limitations? Aware that psychiatry training is personally and intellectually challenging? Do you know whether you tend to do best in places where everyone is really striving or at a place where at least a big chunk of the residents are phoning it in (but which gives you a more ready opportunity to shine and get special attention from the time-starved faculty)? This latter issue is important, and might explain why leaders in the field don't necessarily come from the hotshot programs--most residencies have some top-notch faculty, and they are on the lookout for future stars and writing partners. If you are one of them, great. If you are one of a herd of terrific residents, it can be harder to distinguish yourself. Personally, I woudn't want to be the only academically-oriented person in my residency, but I know others who did very well in that situation.

Nevertheless, opinions do reflect reality to some extent, and there's a reason why some places are perceived by applicants as particularly powerful training experiences. To some extent, they are.

Some additional types of rotations/options available: Often these are available as rotations through other departments.

Click to expand...

Agree with this, and everything else written by my colleagues. I forgot to mention some of the other areas such as gero-psychiatry and community psychiatry among others.

I never did long term psychiatry until I became an attending. My first 2 months were like being in residency all over again because there's always things in a specific clinical environment that the textbooks will never teach you. I eventually was able to figure it out and actually do very well in the position, however, just like a resident, I had to spend a lot of extra hours figuring things out, reading up guidelines, and asking my colleagues if I was missing anything. It wasn't until about 6th month that I had mastered the position to the point where my numbers at work were on par or better than other doctors. By the end of the year-I was actually getting the highest score in the hospital in terms of my performance (e.g. length of stay, patient satisfaction, # of restraints, etc). All of this was due to a lot of extra work on my part having to learn something that a resident could've already learned if their program provided this specific clinical scenario.

I've also noticed that some of the best clinical psychiatrists are the ones that have worked in multiple scenarios. It makes sense. They have an all-around good sense on how to treat all of the psychiatric disorders. Also if you treat in one area you will likely get your patient to another area. E.g. if you do inpatient, you will know more if you have experience with discharging the patient to the right disposition if you know how that disposition operates.

I have seen some programs have very little clinical exposure in a variety of settings. E.g. I know of a program where they do not have a involuntary unit and rarely get dangerous patients. A resident from such a program will have little training in dealing with acute and dangerous patients.

One issue in regards to specific experiences. As someone said, practice doesn't make perfect. Practice makes permanent. From that perspective, exposure to mediocre experiences would be worse than not ever being exposed.